When Debbie Daniels was scheduled to undergo a hysterectomy in 2003, her doctor suggested he do a “tummy tuck” as well.
But the obstetrician/gynecologist did not tell her that he had never been trained to perform the procedure that gets rid of excess skin and fat.
She also did not know he had been kicked off the staff of another hospital for doing tummy tucks without proper credentials — or that he did the procedure unlike any other doctor, according to court records.
Two days after Dr. David Lee Grimes cut Daniels open and stitched her back up, her wound burst, leaving a basketball-sized hole in her belly 7 to 8 inches deep, one of her lawyers said. She had to undergo emergency surgery — the first of many — and be placed in a medically induced coma for a month.
Left permanently disabled, Daniels, then 39, a respiratory therapist in Paducah, sued her doctor. An expert witness hired by his insurance company told the carrier that she was “appalled” by what Grimes did — that it was “inexcusable and indefensible,” according to internal documents the company was later forced to disclose.
But for nearly two years, the company – American Physicians Assurance Corp., which insures many Kentucky doctors – refused to engage in settlement discussions. When it finally made an offer, after nearly two years, it proposed paying Daniels only $75,000, even though the company’s internal documents showed it had valued her damages at $1 million, according to court records.
Unemployed, destitute and unable to keep her two children fed and housed, Daniels eventually accepted the $650,000 the company offered on the eve of the trial of her suit in 2006.
But she reserved the right to sue the company for the settlement delay. And a Jefferson Circuit Court jury, after a weeklong trial and 11 hours of deliberations, awarded her $3.8 million, finding that the insurance company acted in bad faith by delaying payment of her claim when it knew its client was liable.
The verdict included $3,479,277 in punitive damages.
All states have laws like Kentucky’s unfair claims settlement practices act, but Kentucky is one of only a few where juries, rather than state insurance commissioners, impose penalties for violations in cases brought by a patient against their doctor’s insurer.
The statute says it is unlawful for insurers to fail to attempt “in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear.”
This week’s verdict was the second in Kentucky in five weeks in which a jury punished an insurer for acting in bad faith with a third party — a doctor’s patient.
On April 30, a Kenton County jury returned a $2.5 million verdict against Medical Protective Insurance Co. for failing to promptly settle a damage claim with a woman whose doctor severely damaged her inner ear during a simple wax-removal procedure.
She had won a $1.6 million award for her medical damages through arbitration, but the jury found that the insurer made her litigate after liability was clear. Evidence showed an adjuster collected a bonus by reducing claims, said the woman’s lawyer, Austin Mehr.
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